How to Prevent and Rehab an Ankle Sprain

During my first practice in Ireland, I asked a player when he had hurt his right ankle. The player was amazed. “How did you know? It’s been over six months. It’s fine now.”

Ankle injuries are the most common sports injuries, especially for basketball players. Ankle flexibility is important to the health of a basketball player.

“NBA basketball players lose 20 to 25 percent of their ankle flexibility throughout the year because of all the calf work they do,” says Pistons head strength and conditioning coach Arnie Kander…“Your calves get tight from moving forward, and then you start bending everywhere else.” That’s when the injuries start — and why you see so many basketball players come down with ankle sprains by midseason, Kander says.

My player’s ankle may have felt fine, but it was not. Over six months after his injury, his ankle sprain affected his performance. When he shot, he did not extend equally with both ankles – his right ankle did not plantar-flex. He lacked ankle flexibility.

Beyond affecting his shooting, ankle extension begins the triple extension of the ankle, knee and hip when you jump and provides the most power to your jump. A lasting ankle injury – one that is not properly rehabilitated – continues to affect performance long after it has healed (pain dissipated).

Kander suggests a Dynamic Warm-up before each game and practice to increase ankle flexibility and mobility and prevent ankle sprains. After an ankle sprain, the popular response is ice and rest. However, that response is slowly changing:

“In the past few decades, doctors have changed their thinking about the best treatment for sports injuries ranging from sprained ankles and pulled muscles to, in some cases, broken bones. After the initial pain and swelling begins to subside – sometimes in as little as a few days – movement and gentle loading of the injured area seems to help muscles heal better, hasten return to full strength, and reduce the risk of recurrence.”

When I work with young players, I often see players who never rehabilitated their ankle injury and who have reduced range of motion due to scar tissue. I train players who think they have a shooting problem, but they have an ankle flexibility problem.

“If an injured muscle heals without any stress being put on it, it will generally heal in a shortened position, and the affected area will be a bit weaker and more fibrotic [from abnormal scar tissue] than the surrounding tissue,” says Shawn Thistle, the clinic director of Shape Health & Wellness Centres in Toronto. “It ends up being the weak link when you return to activity.”

One simple way to stress the ankle as you recover is simple balance exercises. The New York Times cited a study on balance training and its positive effect on ankle rehabilitation, and consequently ankle injury prevention:

A major review published last year found that six weeks of balance training, begun soon after a first ankle sprain, substantially reduced the risk of a recurrence. The training also lessened the chances of suffering a first sprain.

The article mentions standing on one leg and stabilizing so you are not shaking. Another study published in the British Journal of Sports Medicine indicated that the Single-Leg Balance test is an effective test to predict ankle sprains:

An association was demonstrated between a positive SLB test and ankle sprain. In athletes with a positive SLB test, not taping the ankle imposed an increased risk of sprain. The SLB test is a reliable and valid test for predicting ankle sprains.

To improve the rehabilitation of an ankle sprain, write the alphabet with the other leg. Switch feet, as the injured ankle needs the stability from balancing on one leg and the range of motion from drawing the alphabet. Stand on one leg and use the other foot to write the alphabet in the air. Exaggerate the movements with your toes to flex and extend your ankle as much as possible.

While improving balance has been shown to reduce the likelihood of another ankle sprain, you also want to regain the full range of motion. Writing the alphabet and forcing your foot through the full range of motion breaks down scar tissue and improves ankle flexibility. Many times, players forget this aspect of rehabilitation and return to the court with reduced flexion in their ankle which detracts from their skill performance.

Some other exercises:

With the prevalence of ankle injuries, one major issue is whether or not to wear an ankle brace. A review of several studies is inconclusive.

According to an Australian study published in the British Journal of Sports Medicine, braces were not a factor in one’s susceptibility to an ankle injury. Instead, previous ankle injury was the greatest indicator of a future ankle sprain.

“Players with a history of ankle injury were almost five times more likely to sustain an ankle injury.”

Interestingly, the second biggest indicator was an air cell in the heel:

“Players wearing shoes with air cells in the heel were 4.3 times more likely to injure an ankle than those wearing shoes without air cell.”

“Basketball-shoe midsoles tend to be quite thick, for one thing. In theory, this exaggerated thickness provides better cushioning, but it also makes the foot and ankle more unstable, compared to a situation in which the foot is closer to the ground. In particular, it makes the foot and ankle more prone to the violent side-to-side tipping motions which produce ankle sprains and other ankle injuries.”

As for ankle braces, the commentary noted that:

“Players with a history of ankle injury were more likely to wear an ankle brace, compared to athletes with no prior injury; however, wearing an ankle brace did not significantly reduce the risk of injury.”

Laboratory data has shown that the use of ankle braces has reduced the rate of initial and recurrent injuries.

If one uses an ankle brace, another study found no difference between braces in terms of injury prevention, but the rigid brace showed decreased performance:

With regard to the objective parameters, no significant differences were found between the braces except for the rigid brace which showed decreased values for the vertical jump and longer times for the other tests compared to all other braces.

The same test measured subjective difference through a questionnaire and found differences in comfort level:

The subjective evaluation of the braces revealed significant differences with respect to comfort and handling and therefore, permitted a distinction between semi-rigid and soft braces. Although significant differences between braces were found in subjective performance restriction, no significant differences were revealed in the objective evaluation.

If one uses an ankle brace, choose the brace based on the player’s comfort and feeling, not the supposed benefits.

Beyond ankle braces, one’s shoes are a major factor for potential sprains. The Australian study noted the increased incidence rates with an air cell in the heel. Another study suggests changing shoes often to prevent an injury, a variable not accounted for in the Australian study:

NBA players often change their sneakers every two to three games. This is because there is a proven link between the replacement of sneakers and the prevention of injuries…Even when the outside of the sneaker looks good, the mid-sole of a basketball sneaker (the eva) is often worn down. When this happens, there is added stress to bones and ligaments in the foot and the leg…Currently, the American Academy of Podiatric Sports Medicine is recommending that high school basketball players switch sneakers monthly.

In the end, another study in the Sao Paulo Medical Journal might sum up all the studies the best:

Ankle bracing and ankle taping action mechanisms are still unclear and therefore should be carefully prescribed. More studies are needed to clarify taping and bracing effects on sporting activities.

Before choosing to tape or wear a brace, use a single-leg balance test to assess risk and check the stability of your shoes.